Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

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  Safety and Efficacy of Adjunctive Esketamine vs. MAOIs in TRD in Adults

  Riley Guinan

  Background:

  Depression affects millions globally - Treatment-resistant depression (TRD) is defined as failure to respond to two antidepressant trials of adequate dose and duration

  Traditional Treatment for TRD:

  Switching or adding medications atypical antipsychotics - Limitations include delayed action, side effects, and limited efficacy

  Alternative Treatment Options:

  - Ketamine:

  • A dissociative anesthetic with potential antidepressant effects
  • Targets the NMDA receptor and activates AMPA receptor.
  • Shows rapid and potent antidepressant effects; however, not FDA-approved for depression

  - Monoamine Oxidase Inhibitors (MAOIs):

  • Antidepressants used since the 1950s
  • Inhibits the enzyme metabolizing neurotransmitters.
  • Limitations: Dietary restrictions and drug interactions and longstanding safety concerns

  Importance of Comparison:

  Given limitations of traditional treatments and promising results from Ketamine and MAOIs, there's a need to compare their safety and efficacy. This will provide clinicians with informed choices for their patients.
  

  Objective:

  To compare the safety and efficacy of ketamine and MAOIs for TRD to guide clinical decisions and future research.

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  The Effectiveness of Tirzepatide (GIP/GLP-1 Receptor co-Agonist) vs GLP-1 Receptor Agonists on Lowering A1C in Adults with Type 2 Diabetes Mellitus

  Madison LaPlante

  Introduction

  In the United States, 34.2 million people are currently diagnosed with diabetes mellitus, which accounts for 10.5% of the total population.¹ Type 2 diabetes mellitus (T2DM) holds 94.2% of all diabetes diagnoses. The American Association of Diabetes estimates approximately $327 billion annually and is broken up as follows:¹

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  The Efficacy of Fecal Microbiota Transplantation (FMT) on Symptom Reduction in Patients with Irritable Bowel Syndrome (IBS)

  Carly Liberatore

  Background

  • IBS is a functional gastrointestinal tract disorder that affects 5-10% of the population.¹
  • Symptom severity ranges from mild to severe interference with daily life.¹
  • Current treatments are highly ineffective and focus on relieving symptoms rather than solving the root problem, gut dysbiosis.^{5, 6}
  • Aim: To determine if FMT significantly reduces symptom severity in IBS patients

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  The Safety and Efficacy of Spironolactone versus Oral Antibiotics for Moderate-severe Acne in Post-adolescent Females

  Bhav Patel

  Introduction

  • Acne is a common skin condition when the pores are clogged by particles like dead skin or oil, affecting approximately 50 million individuals in the U.S.¹
  • Over a third of females experience moderate-severe forms that persist into adulthood and that number seems to be on the rise³
  • Persistent moderate-severe acne often requires systemic medications and oral antibiotics are the most frequently prescribed therapy²
  • Dermatologists prescribe more antibiotics per provider than any other specialty, and often for longer durations than recommended²
  • The inappropriate use of oral antibiotics is contributing to bacterial resistance and disruption of the microbiome²
  • Spironolactone is an androgen receptor antagonist that has been used off-label for acne treatment for over 30 years³
  • A 2009 Cochrane review found that randomized trials evaluating spironolactone as a treatment for acne were too limited and small to support its clinical effectiveness¹
  • There have since been multiple large studies supporting its utility¹

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  Augmenting Addiction Management: The Potential Efficacy of Combining rTMS with CBT

  Dylan Schroeder

  Abstract

  Non-substance and substance related addictive disorders contribute a high global disease burden with relatively poor treatment options with poor craving control and high relapse rates. CBT is a well-documented treatment modality which is the cornerstone for top-down behavioral management of cravings and preventing relapse, but its clinical efficacy is limited. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment method which may reduce cravings and relapse rates through a bottom-up neurochemical approach.

  There is potential that the rTMS reduction of bottom-up cravings may synergistically enhance the top-down control of cravings established with CBT. Existing primary research demonstrates that a dual therapy approach has potential to be more effective than respective monotherapies at reducing cravings and relapse rates for patients with alcohol use disorder, nicotine dependence, and gambling disorder.

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  The Combination of Platelet Rich Plasma and Corticosteroids in Musculoskeletal and Musculotendinous Pathologies

  Mikayla Stoudt

  Background

  - 126 million Americans reported to have a musculoskeletal or musculotendinous pathology in 2012¹

  - Combined direct and indirect cost of these injuries in 2015 was $874 billion¹

  - Corticosteroid injections have been the mainstay of invasive management after conservative methods fail
  Long-term effects of corticosteroids

  • Intra-articular injections for knee osteoarthritis resulted in cartilage volume loss¹⁰
  • Harm to flexor tendons, neurovascular structures, and compromised integrity^{7, 11}

  - Platelet Rich Plasma

  • Sample patient blood --> Centrifuge --> Separate plasma and platelets from other blood products --> Reconcentrate the platelets into the plasma
  • Platelets release growth factor beta, vascular endothelial growth factor, platelet derived growth factor, transforming growth factor^{12, 13}
  • Reproduction of cells and regeneration of tissue
  • New application in the management of musculoskeletal and musculotendinous pathologies

  - The goal of this literature review is to discuss possible improved outcomes and patient satisfaction when combining platelet rich plasma with corticosteroids in the management of musculoskeletal and musculotendinous pathologies in adults 18 years or older, versus the use of PRP or corticosteroid injections alone.

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  A Comparison of Bleeding Risk in Patients with Cardiovascular Disease Treated with Aspirin versus Clopidogrel

  LaBoy Alyssa

  Background

  Cardiovascular disease is the leading cause of death for men and women in the United States.⁷­­

  There are four main types of CVD:

  1. Coronary heart disease
  2. Strokes & TIAs
  3. Peripheral arterial disease
  4. Aortic disease

  Coronary artery disease (CAD) is the most prevalent and most common cause of atherosclerosis

  Antiplatelet medications remain the cornerstone of medical therapy for primary and secondary atherosclerotic CAD prevention.

  Aspirin is prescribed for:

  • Individuals with a history of MI or ischemic stroke to prevent a recurrence.
  • When a myocardial infarction (MI) is suspected to avoid further infarction.
  • Thromboembolism prevention after hip surgeries, transient ischemic attack (TIA) prevention, or adults at a higher risk for atherosclerotic CVD.

  Clopidogrel is prescribed for:

  • Individuals with a history of of MIs, ischemic strokes, and peripheral artery disease.
  • Use during a percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable ischemic heart disease.
  • Symptomatic carotid artery stenosis
  • Secondary prevention post-coronary artery bypass grafting
  • Peripheral artery percutaneous angioplasty in peripheral artery bypass grafting

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  Mobile Health as a Potential Tool to Treat Children in Obesity

  Olivia Carey

  Introduction

  • Pediatric obesity prevalence is estimated to be 22% in 2020 of all children in the US³
  • Obesity is defined as greater or equal to the 95th percentile for age and sex⁴
  • Childhood obesity leads to adulthood hypertension, hyperlipidemia, respiratory complications, and reduced quality of life⁴⁴
  • The AAP released new 2023 guidelines that define the standard of care as a multi-modal, chronic-care treatment plan that prescribes healthy eating choices, an increase in physical activity, and mental health support.⁵
  • Mobile health is the use of mobile phones and wireless technology in healthcare³
  • A meta analysis of 24 RCTs found mobile health is effective in the treatment of obesity in adults¹²
  • A potential novel approach such as mobile health may aid in increasing treatment efficacy for children with obesity
  • BMI standard deviation scores (BMI-SDS) or BMI z-scores are measures of relative weight adjusted for child age and sex¹³

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  POCUS Use for Emergency Airway Management in Rural Emergency Departments

  Margaret Downing

  Introduction

  - Preparation and accurate prediction of difficult airways in emergent situations is necessary for successful first pass intubation

  - Current methods for airway assessments require patient cooperation and may vary by provider

  • Mallampati score: open mouth, protrude tongue, see what structures are visible³
  • LEMON criteria: look externally, evaluate 3-3-2 rule, Mallampati score, obstruction, neck mobility
  • Thyromental distance: measure thyroid cartilage to tip of chin with neck extended³

  - Difficult airways have successful first pass intubation only 82.2% of the time (vs 92.4% for non-difficult airways)⁶

  - Adverse effects occurred in 14.2% of patients with successful first pass intubation versus 47.2% in failed first pass attempts⁷

  - First pass success in rural hospitals are 69% versus 95% at trauma centers⁹

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  Tranexamic Use and Safety in Adult Trauma Patients

  Drew Frankenfield

  Problem

  • Trauma is one of the top leading causes of death worldwide with about 1.9 million deaths per year.
  • Mortality due to hemorrhaging trauma, specifically, accounts for 30-40% of all trauma deaths.⁸
  • Mortality is due in part to trauma-induced coagulopathy which has simultaneous bleeding and clotting

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  Trauma-Informed Care PA-S Pilot Program Evaluation

  Karyn Furcolo, Raya Patel, Mihail Petrov, and Leslie Rowland

  Background

  Trauma stimulates the sympathetic nervous system, creates a fight-or-flight response through the hypothalamic-pituitary-adrenal axis, release of cortisol.¹ Repeated stress leads to dysregulation of this response, which can lead to altered stress susceptibility and the inability to cope with stress.² A trauma-informed approach encourages the provision of care to be based on knowledge and understanding of trauma and its widespread implications on patients lives.³

  - Rather than asking "what is wrong with you," trauma-informed care encourages providers to ask "what happened to you?"⁵

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  In Stable Phase COPD Patients does Oral Magnesium Supplementation vs Nothing Decrease the Number of COPD Related Hospitalizations?

  Georgina Garvey

  Introduction

  - Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that leads to significant morbidity and mortality. Magnesium deficiency is known to lead to increased risk of both respiratory and cardiovascular diseases1. This deficiency can lead to an inflammatory state and increased bronchoconstriction that would exacerbate a disease state like COPD.² Magnesium deficiency is seen in aging populations and those with chronic diseases³ and has also been seen in the population of patients coming into the emergency room with acute exacerbations of COPD.⁴

  - Treatment with IV magnesium has been shown to be efficacious in treating COPD exacerbations,⁵ but there is new research investigating oral Magnesium in stable phase COPD patients to prevent acute exacerbations to help improve the quality of life of patients managing this chronic condition.⁶

  - Current standard of care for COPD includes short acting beta agonists, muscarinic blockers, and inhaled glucocorticoids.

  - The theorized pathophysiology of magnesium includes an antagonism of calcium which blocks channels and prevents the release of acetylcholine on the neuromuscular plate. This prevents constriction of bronchial smooth muscle, instead allowing for bronchodilation

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  The Impact of Police Transport of Patients with Penetrating Traumas on Mortality

  Breanne Grove

  Introduction

  • 2020: For people aged 1 to 44 in the U.S., firearm-related injuries ranked in the top five leading causes of death.¹
  • 2022: 44,343 total gun violence deaths, 38,593 gun injuries & 646 mass shootings²
  • 1987: Philadelphia became first U.S. municipality to allow police personnel to follow a “scoop and run” policy.^3,4 Necessity for police transport came from the lack of EMS availability when firearm homicide rates rose by 123%.⁵

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  Reminiscence Therapy for Prevention of Post-Stroke Anxiety and Depression in Adults

  Carly Porter

  Introduction

  Anxiety and depression are prevalent after a stroke.^1,2 Peer support is a non-pharmacologic intervention utilized to manage post-stroke anxiety and depression with inconsistent results.³ Reminiscence therapy is an intervention that has been studied in the dementia population but is a relatively new intervention for the stroke population and has the potential to impact the psychological care provided to stroke patients.⁴

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  Role of Suction-Based Airway Clearance Devices in Pediatric Foreign Body Airway Obstruction

  Rebecca Braver

  Introduction

  • Foreign body airway obstruction (FBAO) represents a significant cause of morbidity and mortality in the pediatric population. Factors including pediatric anatomy, chewing and swallowing difficulties, developmental stages, habits and behaviors, and children’s toys and foods increase risk of FBAO in children.^1,2
  • BLS guidelines for FBAO management in responsive children ages 1-8 call for a series of subdiaphragmatic abdominal thrusts, which increase intrathoracic pressure to force air and the foreign body out of the airway.^3,4 Abdominal thrusts have higher reports of injury compared to all other FBAO interventions, with risk of thoracic, vascular, and gastro-esophageal injury.^5-7
  • Novel suction-based airway clearance devices (ACDs), including LifeVac and Dechoker, are non-powered, externally applied, and utilize a negative pressure system to remove an obstruction from the airway.^6,8 They are straight-forward to use and less invasive than abdominal thrusts.
  • This research aimed to address the following question: In children with foreign body airway obstruction, are suction-based airway clearance devices superior to established pediatric BLS guidelines for abdominal thrusts in terms of successful foreign body removal and ease of use?

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  Impact of Mental Health Boarding in the Emergency Department and Recommendations on How We Can Improve

  Kyra Buettner

  Introduction

  Every year in the United States there is an estimated 2 million adolescents who experience suicidal ideation or attempt suicide.¹ The shortage of behavioral and mental health professionals has led to an increase in emergency department (ED) visits. “Boarding” is defined as “the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made.²” The purpose of this study is to evaluate the following question - in adolescent patients with suicide attempt or mental health crisis, does boarding in the ED result in poorer mental health outcomes? Information from experiences of adolescents who have been boarded in the ED will be used to provide guidelines for emergency departments to better prepare for patients admitted for suicidal and mental health crisis

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  The Impact of Intralesional 5-Fluorouracil in the Treatment of Keloid Scars

  Madeline Derham

  Background

  - The American Academy of Dermatology (AAD) defines a keloid scar as a type of raised scar extending past the initial area of injury¹

  - Approximately 10% of the general population affected - significant risk factors include +family history, darker skin tones, mechanism of injury (burn, surgical)³

  - Symptom presentation: pain, pruritus, burning, increased sensitivity³

  - Varying existing treatment methods with high resistance and recurrence rates leading to no agreed upon standard approach⁵

  • Most widely adopted method currently : intralesional (ILS) steroid ^injection5

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  Stimulant Medication use in Children/Adolescent Athletes with ADHD Reduce the Recovery Time of Concussions and Traumatic Brain Injury

  Matthew Lee

  Introduction

  • Concussions and TBIs are well-known injuries occurring 30-50 million times a year worldwide and are commonly seen in sports.¹ The majority of TBIs are mild yet still have the potential to cause lifelong detrimental effects.
  • Short- and long-term complications include difficulty thinking, difficulty concentrating, changes in emotions and personality, decreased memory and sensation, and may lead to depression and dementia.²
  • Especially in children and adolescents who are undergoing brain development.
  • There are no known prophylactic medications, however, some studies have indicated that sympathomimetic drugs, MPH, may be neuroprotective in the setting of TBIs.
  • The purpose of this study is to identify if the use of MPH reduces recovery time when subject to a brain injury.

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  The Role of Repetitive Transcranial Magnetic Stimulation (rTMS) v. Electroconvulsive Therapy (ECT) in Geriatric Depression Treatment: Efficacy & Tolerability

  Madeleine Sarro

  Background

  • Geriatric depression, or depression in a population over the age of 60, is a highly debilitating mental health condition with a prevalence of 25% versus 10% in the general population.^{1, 2} Increasing prevalence is expected in the next 30 years with a rise in the population size for adults over 60 from 12% to 22%.³
  • Limiting variables in the treatment of geriatric depression include polypharmacy, intolerable adverse effects, medical comorbidities, drug resistance and atypical symptom presentation.^2-7
  • Due to uniformity in underlying pathophysiology, current treatment guidelines for geriatric depression are the same as for the general population.⁸
  • Alternative treatment options, including electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are evolving, but underresearched.⁸